1.

An otherwise healthy 35 year old woman with a history of multiple stress fractures undergoes iliac
biopsy after double tetracycline labelling, The biopsy reveals a relatively normal total bone volume,
but there is increased total osteoid, increased osteoclastic activity and smudged tetracycline labels
with a low mineralization rate. The most likely diagnosis consistent with these findings is

A. osteoporosis
B. osteogenesis imperfecta
C. osteomalacia C
D. primary hyperparathyroidism
E. aluminium toxicity

2, The most important means of preventing viral transmission using human allograft tissue is

A. radiation
B. ethylene oxide
C. removing the marrow E
D. freeze drying
E. adequate donor screening

3. The earliest and most objective sign of compartment syndrome is

A. Pain with passive stretching of the muscles in the involved compartment

B. Paresthesia
C. A tense compartment A
D. Hypoesthesia
E. Paralysis

4. The most desirable position for glenohumeral arthrodesis is

A. 20 degrees of flexion, 30 degrees of abduction, 40 degrees of internal rotation

B. 45 degrees of flexion, 45 degrees of abduction, 45 degrees of internal rotation
C. 10 degrees of flexion, 60 degrees of abduction, 20 degrees of internal rotation A
D. 20 degrees of flexion, 30 degrees of abduction, 90 degrees of internal rotation
E. 10 degrees of flexion, 90 degrees of abduction, 10 degrees of internal rotation

5. A 26-year-old woman falls from a horse and sustains a four-part fracture-dislocation of her
nondominant arm. In performing a humeral head replacement, which of the following concepts is
most important to maximize functional outcome ?

A. Keep retroversion within 5 degrees of anatomic retroversion

B. Reestablish tension in the deltoid and cuff myofascial sleeve
C. Resurface the glenoid to minimize subsequent erosion B
D. Lateralize the lesser tuberosity to minimize anterior instability
E. Reattach the greater tuberosity distally to increase supraspinatus lever arm

6. A gun stock deformity seen as a result of malunion of a supracondylar fracture consists of which of
the following components ?

A. VaIgus, external rotation, flexion

B Varus, internal rotation, extension
C. Varus, external rotation, extension B
D. VaIgus, internal rotation, flexion
 E. VaIgus, internal rotation, extension

7. Of the following pelvic osteotomies used in the treatment of acetabular dysplasia in the.adult patient
leaves the "teardrop" in its original position and redirects the acetabulum?

A. Steel
B, Chiari
C. Ganz periacetabular C
D. Dial or spherical
E. Salter's innominate

8. In normal young adult human articular cartilage, the tangential zone consists of

A. numerous extracellular mitochondria.

B. a high concentration of proteoglycan aggregate,
C. high concentration of collagen fibers. C
D. mature rounded chondrocytes.
E. chondrocytes in short columns.

9. In general, the changes in knee range of motion from preoperative compared to ultimate
postoperative range of motion is most dependent on what factor?

A. Type of prosthesis
B. Initiation of continuous passive motion (CPM) by the third postoperative day
C. Preoperative knee range of motion C
D. Need for medial release to correct varus malalignment
E. Sacrifice of the posterior cruciate ligament

10.Which of the following condition is a contraindication to performing a vaIgus femoral intertrochanteric

osteotomy?

A. Fixed adduction
B. Fixed abduction
C. Flexion of 90 degrees B
D. Osteoarthritis
E. Leg length discrepancy

11. Which technique improves the compressive modulus of cement?

A. Use of low viscosity cement

B. Finger packing of cement
C. Insertion of a vent tube A
D. Addition of antibiotics to cement
E. Reduction of cement porosity

12. Which of the following conditions is related to failure of a high tibial osteotomy?

A. Varus secondary to metaphyseal bowing

B. Posttraumatic medial arthritis in a patient with preinjury varus
C. Grade III chondromalacia of the superomedial patella D
D. Varus alignment in the presence of a high adduction moment
E. Patient age of 68 years or older
13. Total hip replacement in a patient with a long-standing hip fusion on the other side is most likely to
result in

A. a higher rate of infection

B. a higher rate of mechanical failure and loosening
C. a higher rate of myositis ossificans B
D. an improved gait efficiency compared to patients without a fused hip
E. a greater incidence of dislocation

14. An infected total hip replacement is treated with implant removal and insertion of an antibiotic-laden
cement block. When does the local level of antibiotic release cease to be significant?

A. In 10 days
B. In 6 weeks
C. In 12 weeks B
D. In 6 months
E. In 1 year

15. Core decompression for osteonecrosis of the femoral head has the highest likelihood of success
when performed during which ficat stage?

A. I
B. IIA
C. IIB A
D. III
E. IV

16. A 78-year-old man is seen in the emergency room with groin pain on weightbearing after reportedly
falling at home, The patient complains of pain in the proximal portion of the leg on all motions, Plain
radiographs are negative, The most effective plan in establishing a diagnosis of hip fracture is to

A. allow the patient to use a walker and repeat plain radiographs in 1 week
B. perform tomograms immediately
C. perform an MRI scan immediately C
D. admit patient to hospital; perform repeat plain radiographs if symptoms persist
E. admit patient to hospital; perform Tc-99m bone scan if symptoms persist

17.During high strain activity such as running or jumping, what is the mechanism of action of the
hyalurinan molecules of synovial fluid in the knee joint?

A. Making configuration adjustments to establish a viscous fluid in the knee joint?

B. Breaking down to form a thin, small molecule lubricating fluid
C. Becoming entangled, behaving like an elastic solid C
D. Absorbing water from the surrounding articular cartilage
E. Increasing overall concentration

18. A 36-year-old woman complains of hip pain that severely limits her activity and is unresponsive to
nonsurgical management. Examination demonstrates a bilateral Trendelenberg sign and minimal
loss of motion. Radiographs reveal hip dysplasia, narrowing of 50% in the superior joint acetabular
cyst, and spur formation. The femoral head is partially uncovered and is in apparent valgus. The joint
is not congruent, Recommended treatment should be
 A. arthrodesis
B. Steel osteotomy
C. Chiari osteotomy, C
D. cementless total hip arthroplasty
E. varus intertrochantric femoral osteotomy

19. Successful arthrodesis using external fixation following debridement of an infected replacement is
most dependent on what factor?

A. Type of infecting organism

B. Degree of bone loss
C. External fixator frame configuration B
D. An immunocompromised patient
E. Underlying diagnosis of rheumatoid arthritis

20. A 50-year-old man has osteoarthritis of the knee, which is functionally limiting and is now
unresponsive to nonsurgical treatment, Favorable results arthroscopic debridement can be expected
based on what factor?

A. Duration of symptoms for 5 years or more

B. Varus malalignment
C. Advanced radiographic degenerative changes D
D. Localized medial joint line pain with degenerative meniscal tear
E. History of chronic synovitis

21. You are planning a valgus tibial osteotomy. The patient has 5 degrees of mechanical varus (0
degrees anatomic) when supine, and 15 degrees when standing on the affected leg. How many
degrees of correction are needed ?

A. 5
B. 10
C. 15 C
D. 20
E. 25

22. 38 year old man who has numbness and pain in both legs has had pain in his back for about 1
month after lifting a box. The pain in his back improved just before he started to notice the
numbness and pain in the legs, He states that he has not urinated for 24 hours, and today, his
buttock feels "funny" when scratched. Examination reveals that his abdomen is somewhat bloated.
Which of the following diagnostic tests should be performed?

A. MRI Scan
B. Electromyography (EMG)
C. Lumbar spine radiographs and EMG A
D. Lumbar spine radiographs and spinal fluid analysis
E. Cytometrogram (CMG) and somatosensory potentials (SSEP)

23. What is the most appropriate routine prophylaxis to prevent venous thromboembolism in patient s
who undergo spinal surgery?

A. Aspirin
 B. Heparin
C. Enoxaparin E
D. Sodium warfarin
E. Compression stockings

24. Which of the following statements about congenital cervical stenosis as it relates to contact
sport is true?

A. it is unrelated to the occurrence of "stingers"

B. it is associated with a higher incidence of cervical spine fracture
C. it is an absolute contraindication to participation in contact sports E
D. It has been shown to be associated with the subsequent development of permanent quadriplegia
E. It is frequently present in athletes who has had an episode of transient neurapraxia of the spinal
cord

25. Which of the following factors is important in predicting a surgical outcome for lumbar disk
herniation?

A. leg weakness
B. reflex change
C. clear history of injury E
D. disk herniation on MRI scan
E. positive straight leg raising sign

26. Which of the following statements most accurately describes normal sagital alignment in the lumbar
spine?

A. the lordosis is equally distributed between the vertebral bodies and the disks
B. all of the lordosis exists within the vertebral bodies and none within the disks
C. all of the lordosis exists within the vertebral bodies and none within the vertebral bodies E
D. most of the lordosis exists within the vertebral bodies and less within the disks
E. most of the lordosis exists within the disks and less within the vertebral bodies

27. Examination of a patient with a neurologic impairment reveals normal sensory function. Which of
the following conditions should be suspected?

A. infection
B. multiple sclerosis
C. herniation of the cervical disk D
D. amyotropic lateral sclerosis (ALS)
E. ossification of the posterior longitudinal ligament

28. A 38-year -old man has radioculopathy of the left lower extremity due to far lateral disk herniation at
L4-5, Which of the following nerve roots is most likely affected?

A. L2
B. L3
C. L4 C
D. L5
E. S1
29. A patient with respirator-dependent quadriplegia is best described by which of the following
functional levels?

A. Functional level above C4

B. functional level above C5
C. recovery of the C4 nerve root A
D. some motion in the deltoid and biceps
E. ability to control an electric wheelchair with limited hand controls

30. A 64-year-old woman has discomfort in her back, cold feet, and pain in both legs that travels down
the calves to the feet. These sensations are present while sitting, but worsen after walking, The pain
significantly diminishes when she stops walking. In the past she has been told she has "arthritis" in
her spine. Examination shows no objective sensory or motor deficits. The pain is progressively
worsening, and she is now unable to cook or clean. Which of the following studies should be
included in the initial diagnostic workup?

A. MRI scan and electromyography (EMG)

B. CT scan and somatosensory potentials (SSEP)
C. Lumbar spine radiographs and EMG E
D. Lumbar spine radiographs, EMG, and selective nerve root blocks
E. Lumbar spine radiographs and examination of pulses with Doppler vascular study

31. A 70 year old man who has a long history of neck pain struck his forehead during a fall.
Examination reveals that he is unable to move his arms and is profoundly weak in both lower
extremities, but he does have some voluntary motor function. Perianal sensation in intact to sharp
and dull testing, and radiograps show no evidence of fracture, The most likely diagnosis is what
neurologic syndrome?

A. Brown-Sequard
B. Central cord
C. Anterior cord B
D. Posterior cord
E. Posttraumatic cord

32. A 20 year old man has had low back pain for the past 2 months that interferes with his ability to
return to work, He has had no injury or treatment to date. A complete workup reveals a 10% (grade
1) L5 S1 isthmic spondylolisthesis. Treatment should include
A. flexion exercises
B. rotation exercises
C. extention exercises A
D. choiropractic manipulation
E. assurances and a return to work

33. The gastrocnemius muscle acts as a load absorbed during what phase of running?
A. swing
B. early stance
C. fifth metatarsal strike D
D. push-off
E. lift

34. What structure is the primary stabilizer for the medial aspect of the elbow?
 A. common flexor tendon
B. biceps aponeurosis
C. posterior band of the medial collateral ligament D
D. anterior band of the medial collateral ligament
E. radial head

35. The mechanism of injury most commonly associated with Achilles tendon rupture is
A. forced plantar flexion of the dorsiflexed foot
B. Supination-external rotation of the plantarflexed foot
C. high velocity impact to the heel D
D. forced dorsiflexion of the plantarflexed foot
E. a direct blow to the Achilles tendon

36. A 20 year old man sustains a direct blow to the anteromedial aspect of his leg while playing soccer.
He has immediate pain and is unable to walk. Examination at 30 degrees of knee flexion
demonstrates increased posterior translation and external rotation. At 90 degrees of flexion,
posterior translation and external rotation decrease. Radiographs are normal. Physical examination
indicates injury to what tissue (s)?

A. ligaments of Wrisberg and Humphrey

B. oblique portion of the medial collateral ligament (MCL)
C. lateral collateral ligament (LCL) E
D. posterior cruciate ligament (PCL)
E. posterolateral complex

37. A 35 year old man presents with a chief complain of vague shoulder pain and weakness shortly
after hiking with a heavy backpack. Examination reveals winging of the scapula when the patient
performs a wall push-up, but no other focal neurologic findings. The most likely diagnosis is

A. long thoracic nerve injury

B. axillary nerve injury
C. suprascapular nerve injury A
D. spinal access ory nerve injury
E. brachial plexopathy

38. Three clinical problems that have been found to be commonly associated in actively exercising
females are

A. amenorrhea, osteoporosis, and anorexia

B. dysmenorrhea, osteopenia, and bulimia
C. anemia, osteoporosis, and amenorrhea A
D. anemia, osteopenia, and bulimia
E. anemia, osteoporosis, and anorexia

39. Which of the following factors is most likely to predispose a muscle to injury?

A. a high percentage of type I (slow-twitch) fibers

B. an origin and insertion that spans one joint (as opposed to a two-joint muscle)
C. a more superficial muscle E
D. a large cross sectional volurne
E. eccentric loading
40. A 42 year old woman sustained a twisting injury to her knee while skiing 1 day ago. She felt a "pop"
but was able to ski down the hill. Because of pain and muscle spasms, an adequate manual knee
examination cannot be performed. Anteroposterior and lateral radiographs of the knee are normal.
The next step in management is

A. repeat physical examination after controlling pain and swelling

B. MRI scan
C. Immediate arthroscopy A
D. Immobilization of the knee for 4 weeks
E. KT-1000 arthrometer testing

41. An 18 year old woman who is an elite gymnast present with a stress fracture and a history of
irregular menses. A probable cause of her secondary oligomenorrhea is

A. pituitary tumor
B. thyroid dysfunction
C. adrenal dysfunction D
D. exercise
E. pregnancy

42, The primary function of the meniscus is to

A. stabilize the knee

B. facilitate motion
C. protect the ligaments from injury D
D. distribute load on the tibial plateau
E. prevent synovial impingement

43. A 14 year old girl who is a gymnast complains of increasing back pain. There has been no specific
trauma, other than her normal workouts and competition. On examination, pain is produced with
flexion an extension and the neurologic examination is entirely normal. Based on the history and
physical findings, the most likely diagnosis is

A. disk herniation
B. traumatic gpondylolysis
C. dysplasia spondylolysis B
D. spinal cord tumor
E. vertebral osteomyelitis

44. A 19 year old man who plays soccer tears his anterior cruciate ligament (ACL) and chooses not to
have reconstructive surgery. Four months later, he undergoes open repair of a medial meniscus tear
that measures 15 mm in length and is located in the meniscocapsular junction posteriorly, No
extensive damage is noted in the body of the meniscus. He return to soccer 6 months after surgery
but 18 months later retears his meniscus, This failure (retear) is caused by what factor?

A. use of an open technique that devascularized the meniscus

B. delay between injury and meniscus repair
C. use of an absorbable suture at surgery D
D. persistent ACL instability
E. premature return to athletics

45. Anabolic-androgenic steroids have what adverse effect on the male reproductive system?
 A. increased testosterone levels
B. increased testicular size
C. enhanced gonadotropin production D
D. oligosperma
E. metabolism of estrogenic compounds to androgens

46. The most important factor in preventing non-union in a massive allograft reconstruction is

A. performing the surgery prior to the administration of chemotherapy

B. exact interposition of the graft-host bony osteosynthesis site
C. rigid fixation C
D. bone grafting of the osteosynthesis site
E. electrical stimulation

47. A 51 year old woman recovering from a Colles' fracture sustained while jogging asks you about her
need for calcium supplementation to her diet. The only time she drinks milk is with 3 cups of coffee
daily but she enjoys 6 ounces of yogurt for lunch. She mentions a strong family history of
nephrolithiasis. You should recommend

A. avoidance of calcium supplements

B. 3,000 mg of calcium carbonate daily
C. 1,500 mg of calcium citrate daily C
D. 1,25 dihydroxyvitamin D, 25 micrograms per day with 800 mg of calcium carbonate
E. 1,25 dihydroxyvitamin D, 25 micrograms per day ; low calcium diet

48. A 65 year old man who is an alcoholic has a displaced femoral neck fracture. Radiographs show
the fracture but also suggest that the cortices of the femur are very thin with absent trabeculae, A
bipolar hemiarthroplasty is implanted as treatment for the fracture. The femoral head and neck are
submitted to pathology, According to the pathology report, the bone of the femoral head shows a
fibrous marrow with abundant osteoclasts and wide osteoid seams. The most likely diagnosis is

A. osteoporosis
B. osteomalacia
C. primary hyperparathyroidism B
D. Paget's disease
E. fracture callus

49, The recommended treatment of parosteal osteosarcoma, graded by the Musculoskeletal Tumor
Society (MSTS) as 113, is

A. chemotherapy
B. irradiation
C. wide excision C
D. amputation
E. observation

50. A 4 year old boy is referred for evaluation because of history of repeated fractures. The child has
had three femoral shaft fractures, all resulting from simple falls. The humerus and clavicle have also
been fractured, Radiographs reveal cortices with poorly defined trabeculae. Blood chemistry profiles,
including calcium, are within normal limits. The most likely cause of this patient's multiple fractures is
A. osteomalacia
B. secondary hyperparathyroidism
C. familial hypophosphatasia D
D. osteogenesis imperfecta
E. osteoporosis